髋膝关节置换术患者术前肌肉质量减少的相关因素分析

杨伶俐; 范杨; 杨柳; 杨仪文; 刘梦瑶; 岑媛; 王子明; 熊雁; 任辉

doi:10.16016/j.2097-0927.202109045

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髋膝关节置换术患者术前肌肉质量减少的相关因素分析

临床医学 | 更新时间：2026-01-09

- 髋膝关节置换术患者术前肌肉质量减少的相关因素分析
- Related factors for skeletal muscle mass loss in patients before hip and knee replacement: analysis on 267 cases
- 陆军军医大学学报 2022年44卷第4期页码：371-378
- 作者机构：
  
  1.400038 重庆，陆军军医大学(第三军医大学)护理系护理管理学教研室
  2.400042 重庆，陆军特色医学中心: 骨科(关节病区)
  3.400042 重庆，陆军特色医学中心: 营养科
- 作者简介：
  
  [熊雁，E-mail: xiongyandoctor@163.com XIONG Yan, E-mail: xiongyandoctor@163.com
  [任辉，E-mail: renhui_tmmu@163.com REN Hui, E-mail: renhui_tmmu@163.com
- 基金信息：
  
  重庆市科卫联合医学基金青年项目(2019QNXM008);作者贡献声明杨伶俐设计研究方案、收集样本、处理数据、撰写和修改论文；范杨参与样本收集、数据处理及修改论文；杨柳、杨仪文、刘梦瑶、岑媛、王子明参与数据收集；共同通信作者任辉、熊雁参与研究设计、课题实施及修改论文。
- DOI：10.16016/j.2097-0927.202109045
  中图分类号： R195.4;R322.74;R687.4
- 收稿：2021-09-06，
  
  修回：2021-11-02，
  
  纸质出版：2022-02-28
- 稿件说明：
移动端阅览
杨伶俐, 范杨, 杨柳, 等. 髋膝关节置换术患者术前肌肉质量减少的相关因素分析[J]. 陆军军医大学学报, 2022,44(4):371-378.

Lingli YANG, Yang FAN, Liu YANG, et al. Related factors for skeletal muscle mass loss in patients before hip and knee replacement: analysis on 267 cases[J]. Journal of Army Medical University, 2022, 44(4): 371-378.
杨伶俐, 范杨, 杨柳, 等. 髋膝关节置换术患者术前肌肉质量减少的相关因素分析[J]. 陆军军医大学学报, 2022,44(4):371-378. DOI： 10.16016/j.2097-0927.202109045.

Lingli YANG, Yang FAN, Liu YANG, et al. Related factors for skeletal muscle mass loss in patients before hip and knee replacement: analysis on 267 cases[J]. Journal of Army Medical University, 2022, 44(4): 371-378. DOI： 10.16016/j.2097-0927.202109045.

摘要

目的

调查髋膝关节置换术患者术前肌肉质量减少的发生情况及相关影响因素。

方法

纳入2020年8月至2021年6月在陆军特色医学中心骨科拟首次行髋或膝关节置换术的患者267例，收集患者人口学资料、疾病史和实验室指标，采用营养风险筛查(nutrision risk screening 2002

NRS2002)量表评估营养状况，采用座椅实验、3 m折返实验和6 min行走测试评估下肢肌肉力量和关节功能活动能力。根据亚洲肌少症工作组2019推荐使用生物电抗阻分析法(bioelectrical impedance analysis，BIA)诊断肌肉量减少的筛查标准，将患者分为肌肉质量减少组(

=94)和肌肉质量正常组(

=173)，分析肌肉质量减少的相关因素。

结果

肌肉质量减少的检出率为35.21%，两组患者下肢关节功能表现3 m折返实验(

=-4.744

＜0.001)和6 min行走测试(

=-4.889

＜0.001)比较，差异有统计学意义。两组患者年龄、BMI、营养风险筛查、使用助行器、血红蛋白、血清白蛋白、血清前白蛋白、淋巴细胞计数、C反应蛋白差异均有统计学意义(

＜0.05)。多因素Logistics回归分析结果显示，体质量指数BMI[

=0.640，95%

(0.557

0.734)

]

是发生肌肉质量减少的独立保护因素，年龄[

=1.093，95%

(1.057

1.132)

]

和使用助行器[

=2.956，95%

(1.179

7.410)

]

则是其发生的危险因素。多元线性回归分析肌肉质量的影响因素，男性肌肉质量高于女性(β=0.846

＜0.001)，年龄(β=-0.245

＜0.001)和吸烟(β=-0.170

=0.024)与肌肉质量呈负相关，血红蛋白(β=0.149

=0.017)与肌肉质量正相关。

结论

选择髋膝关节置换术患者肌肉质量减少发生率较高，年龄、BMI、使用助行器可能与其发生有关，性别、年龄、血红蛋白含量可能作为患者术前肌肉质量的预测指标。

Abstract

Objective

To investigate the incidence of preoperative skeletal muscle mass (SM) loss and related influencing factors in patients with hip or knee replacement.

Methods

A cross-sectional survey was performed on 267

patients who planned to undergo hip or knee replacement for first time from August 2020 to June 2021 in Army Medical Center. The demographic data

disease history and laboratory indicators were collected. Nutritional risk screening 2002 (NRS2002) scale was used to assess nutritional status

and chair test

3-m reentry test and 6-min walking test were employed to evaluate lower extremity muscle strength and joint functional mobility. According to the screening criteria for bioelectrical impedance analysis (BIA) recommended by 2019 Consensus of Asian Working Group for Sarcopenia

the patients were divided into muscle mass reduction group (

=94) and normal muscle mass group (

=173). The related factors of muscle mass loss were analyzed.

Results

The detection rate of muscle mass loss was 35.21%. Statistical significances were seen in lower extremity joint function performance between the 2 groups by 3-m reentry test (

=-4.744

0.001) and 6-min walking test (

=-4.889

0.001). There were significant differences in age

BMI

results of nutritional risk screening

usage of walking aid

lymphocyte count

and levels of hemoglobin

serum albumin

serum prealbumin

and C-reactive protein between the 2 groups (

0.05). Multivariate logistic regression analysis showed that BMI (

=0.640

95%

: 0.557~0.734) was an independent protective factor for muscle mass loss

and age (

=1.093

95%

: 1.057~1.132) and usage of walking aid (

=2.956

95%

: 1.179~7.410) were risk factors. Multiple linear regression analysis indicated that the influencing factors of muscle mass were sex (muscle mass of men larger than that of women

β=0.846

0.001)

age (β=-0.245

0.001)

history of smoking (β=-0.170

=0.024)

and hemoglobin (β=0.149

=0.017)

and age and smoking were negatively and hemoglobin was positively correlated with muscle mass.

Conclusion

Loss of muscle mass is more common in patients who choose hip or knee arthroplasty. Age

BMI

and use of walking aids may be related to the occurrence of muscle mass loss in them

and gender

age

and hemoglobin content may be used as predictors of preoperative skeletal muscle mass.

关键词

Keywords

references

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